Acupuncture little better than 'sham' for migraine

NEW YORK (Reuters Health) - Traditional Chinese acupuncture seems little better than a "sham" version of the procedure when it comes to preventing migraines, a study published Monday suggests.

The findings, reported in the Canadian Medical Association Journal, add to a pattern commonly seen in studies on acupuncture and migraines.

Many have found that people with migraines can get relief from acupuncture. But often, "true" acupuncture has worked no better than "sham" acupuncture -- where the needles are inserted only to a superficial depth in the skin, or into sites that are not considered acupuncture points in traditional medicine.

That raises the question of whether acupuncture works by "non-specific" effects, according to the researchers on the new study, led by Dr. Ying Li of Chengdu University of Traditional Chinese Medicine in China.

That is, some people might feel better because they expect to, or because of the personal attention from the acupuncturist.

But other experts said that the findings do not mean that acupuncture offers nothing more than a "placebo effect" for migraine sufferers.

For the study, Li's team recruited 480 adults who had migraines at least twice a month.

They randomly assigned people to one of four groups: In three, patients were given one of three different types of acupuncture that focused on traditional points, with electrical stimulation added to the needling; the fourth group received a sham version.

In the sham group, needles were inserted in the skin at non-traditional sites, with electrical stimulation. But the needles were not manipulated to create a so-called "de qi" sensation.

Patients in all four groups were offered 20 acupuncture sessions over four weeks.

In the month after treatment ended, migraine sufferers in all four groups were reporting fewer headache days, Li's team found.

On average, they had migraine pain on about three days out of the month -- down from around six days at the study's start.

In the third month after treatment, the "real" acupuncture groups were doing slightly better, while the sham group held steady at around three headache days. But the advantage was "clinically minor," according to Li's team, who did not respond to requests for comment.

'SHAM' MAY HAVE REAL EFFECTS

So does that mean acupuncture's benefits are all in your head?

No, according to Dr. Albrecht Molsberger, of Ruhr University Bochum in Germany, who wrote an editorial published with the study.

The problem, he told Reuters Health by email, is that sham acupuncture is not a true placebo -- and may have real physiological effects.

According to traditional Chinese medicine, acupuncture eases pain by stimulating certain points on the skin believed to affect the flow of energy, or "qi" (pronounced "chee"), through the body.

But some modern research suggests that the needle stimulation triggers the release of pain- and inflammation-fighting chemicals in the body, even if it doesn't strictly follow traditional principles.

"The sham acupuncture effect is so strong and long lasting, that this suggests that other factors, like the stimulation of cytokines or endorphins, are important too," Molsberger said.

And even though real acupuncture has not clearly beaten the sham version, it has outperformed standard migraine treatments in some studies.

A recent research review looked at four clinical trials that tested acupuncture against medications proven to prevent migraine attacks. Overall, acupuncture patients reported somewhat fewer migraines in the couple months after treatment, with fewer side effects.

Dr. Jongbae J. Park, who directs Asian Medicine & Acupuncture Research at the University of North Carolina at Chapel Hill School of Medicine, agreed that the sham in this study was not a true placebo.

"In my mind, it's far from being a true 'control,'" Park said in an interview.

In fact, Park said, the issue with acupuncture research in general is that sham procedures vary from study to study.

Researchers need to settle on a form of true placebo that is used consistently, according to Park -- who acknowledged that questions about acupuncture's effectiveness remain, and further studies are needed.

But based on research overall, acupuncture "should be an option" for treating migraines, said Molsberger, who is also president of Forschungsgruppe Akupunktur, which profits by offering acupuncture training.

Acupuncture is considered a generally low-risk procedure, with side effects like bruising at the needle site. The cost can vary widely -- and may or may not be covered by insurance -- but a session would typically start around $100.

At his center, Park said a typical migraine patient might start with six weekly sessions, and then come monthly, tapering down to once every six months. But the acupuncture sessions would also involve "whole-person" care, with advice on diet, sleep and other lifestyle habits.

There are, of course, other ways to tackle migraines. Several types of medications can prevent attacks, including a group of drugs known as triptans, certain antidepressants, high blood pressure drugs and anti-seizure medications.

Another non-drug option is biofeedback, in which people learn to control the physical responses to stress, like muscle tension -- which may help head off or ease migraine pain.